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To (1) understand the role of antibiotic-associated adverse events (ABX-AEs) on antibiotic decision-making, (2) understand clinician preferences for ABX-AE feedback, and (3) identify ABX-AEs of greatest clinical concern.
Design:
Focus groups.
Setting:
Academic medical center.
Participants:
Medical and surgical house staff, attending physicians, and advanced practice practitioners.
Methods:
Focus groups were conducted from May 2022 to December 2022. Participants discussed the role of ABX-AEs in antibiotic decision-making and feedback preferences and evaluated the prespecified categorization of ABX-AEs based on degree of clinical concern. Thematic analysis was conducted using inductive coding.
Results:
Four focus groups were conducted (n = 15). Six themes were identified. (1) ABX-AE risks during initial prescribing influence the antibiotic prescribed rather than the decision of whether to prescribe. (2) The occurrence of an ABX-AE leads to reassessment of the clinical indication for antibiotic therapy. (3) The impact of an ABX-AE on other management decisions is as important as the direct harm of the ABX-AE. (4) ABX-AEs may be overlooked because of limited feedback regarding the occurrence of ABX-AEs. (5) Clinicians are receptive to feedback regarding ABX-AEs but are concerned about it being punitive. (6) Feedback must be curated to prevent clinicians from being overwhelmed with data. Clinicians generally agreed with the prespecified categorizations of ABX-AEs by degree of clinical concern.
Conclusions:
The themes identified and assessment of ABX-AEs of greatest clinical concern may inform antibiotic stewardship initiatives that incorporate reporting of ABX-AEs as a strategy to reduce unnecessary antibiotic use.
In a multicenter cohort of 963 adults hospitalized due to coronavirus disease 2019 (COVID-19), 5% had a proven hospital-acquired infection (HAI) and 21% had a proven, probable, or possible HAI. Risk factors for proven or probable HAIs included intensive care unit admission, dexamethasone use, severe COVID-19, heart failure, and antibiotic exposure upon admission.
Smoking prevalence is higher amongst individuals with schizophrenia and depression compared with the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS).
Methods
We conducted two-sample MR to explore the bi-directional effects of smoking on schizophrenia and depression. For smoking behaviour, we used (1) smoking initiation GWAS from the GSCAN consortium and (2) we conducted our own GWAS of lifetime smoking behaviour (which captures smoking duration, heaviness and cessation) in a sample of 462690 individuals from the UK Biobank. We validated this instrument using positive control outcomes (e.g. lung cancer). For schizophrenia and depression we used GWAS from the PGC consortium.
Results
There was strong evidence to suggest smoking is a risk factor for both schizophrenia (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.67–3.08, p < 0.001) and depression (OR 1.99, 95% CI 1.71–2.32, p < 0.001). Results were consistent across both lifetime smoking and smoking initiation. We found some evidence that genetic liability to depression increases smoking (β = 0.091, 95% CI 0.027–0.155, p = 0.005) but evidence was mixed for schizophrenia (β = 0.022, 95% CI 0.005–0.038, p = 0.009) with very weak evidence for an effect on smoking initiation.
Conclusions
These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.
Yearly, there are over six million cataract surgeries worldwide that involve intraocular lenses (IOLs) [1]. However, preventing post-operative biofouling of these lenses remains a challenge. One major complication is post-operative bacterial infection [2]. Surface modification of IOLs may provide a solution. This study proposes the use of the anti-adhesive protein lubricin (LUB), a glycoprotein found in the synovial fluid, as a means to make polymer surfaces less prone to bacterial adhesion and proliferation, thus reducing the opportunity for post-operative infection [3]. This study used extended bacteria growth trials in the presence of lubricin, vitronectin, and mucin to investigate how lubricin and protein sub-regions of lubricin reduce bacterial functions. This study showed for the first time that polymer surface coatings of lubricin and vitronectin significantly reduce Staphylococcus aureus growth over the course of 15 hours, while mucin was only able to delay the start of the Staphylococcus aureus exponential growth phase and retard proliferation. In solution, both lubricin and mucin significantly reduce bacterial proliferation. Thus, the results of this study demonstrated that lubricin and its sub-regions mucin and vitronectin should be studied for a wide range of antibacterial applications.
Lubricin is an amphiphilic glycoprotein that is found in the synovial fluid [1]. This protein holds promise as an anti-biofouling agent. This study investigated lubricin’s ability to prevent bacterial attachment and proliferation on intraocular lenses. The findings from this study indicated that lubricin is able to reduce the attachment of Staphylococcus aureus to poly (methyl methacrylate) intraocular lens. Lubricin coatings were confirmed on the surfaces after a 2 hour soak by changes in surface energy. Also, lubricin reduced bacterial proliferation.
Bacterial infection of bone (called osteomyelitis) is of great concern to the medical community. In addition to bone, numerous medical devices are susceptible to microbial colonization when implanted. These infections are chronic since bacteria form a robust adhesion to surfaces, can be protected by sticky slime matrix (called a biofilm) from the body’s immune system (which would otherwise naturally clear the bacteria), and antibiotic treatments may not resolve such infections (due to antibiotic resistance). Here, the multifunctional properties of magnetic nanoparticles (termed here superparamagnetic iron oxide nanoparticles, or SPION) will be explored for their antibacterial activity, magnetic properties, and drug deliverable properties. This study provides a first step towards the development of a new type of pharmaceutical useful for orthopedic or other device related infections by demonstrating physical (magnetic) control of antibiotics towards bacteria and biofilms.
Previous 14C determinations obtained on two segments of a single mastodon bone recovered from Monte Verde, Chile, were highly discordant, differing by more than 5,000 years. Because of the significance of this site in discussions concerning the earliest peopling of the Western Hemisphere, additional 14C and new δ13C values have been obtained on organic fractions isolated from both segments. The constituent amino acid profiles indicate that both bone segments retain significant amounts of protein (mostly collagen) residues. Four accelerator mass spectrometry-based 14C values obtained on total amino acids and ultrafiltered gelatin fractions—two from each segment—are statistically identical and indicate an age of 12,460 (± 30) BP for the mastodon. This value is concordant with 14C values obtained on other culturally affiliated organics associated with the MV-II levels at this site.
New radiocarbon calibration curves, IntCal04 and Marine04, have been constructed and internationally ratified to replace the terrestrial and marine components of IntCal98. The new calibration data sets extend an additional 2000 yr, from 0–26 cal kyr BP (Before Present, 0 cal BP = AD 1950), and provide much higher resolution, greater precision, and more detailed structure than IntCal98. For the Marine04 curve, dendrochronologically-dated tree-ring samples, converted with a box diffusion model to marine mixed-layer ages, cover the period from 0–10.5 cal kyr BP. Beyond 10.5 cal kyr BP, high-resolution marine data become available from foraminifera in varved sediments and U/Th-dated corals. The marine records are corrected with site-specific 14C reservoir age information to provide a single global marine mixed-layer calibration from 10.5–26.0 cal kyr BP. A substantial enhancement relative to IntCal98 is the introduction of a random walk model, which takes into account the uncertainty in both the calendar age and the 14C age to calculate the underlying calibration curve (Buck and Blackwell, this issue). The marine data sets and calibration curve for marine samples from the surface mixed layer (Marine04) are discussed here. The tree-ring data sets, sources of uncertainty, and regional offsets are presented in detail in a companion paper by Reimer et al. (this issue).
The report of the United Nations Association (UNA) National Policy Panel on China, The United Nations and United States Policy is one of the most thoughtful and responsible documents to emerge from the many discussions of this subject that have been going on all over the country in recent months.